deaths due to suffocation result when the child is in a place or
position where he or she is unable to breathe. In 2000, there were
1,580 suffocations, including 842 unintentional deaths, 568 suicides,
107 homicides and 63 deaths of undetermined manner in the United
States. Most of the unintentional suffocations are caused by:
- Overlay: a person who is sleeping with a child
rolls onto the child and unintentionally smothers the child.
- Positional asphyxia: a child’s face becomes
trapped in soft bedding or wedged in a small space such as between a
mattress and a wall or between couch cushions.
- Covering of face or chest: an object covers a
child’s face or compresses the chest, such as plastic bags, heavy
blankets or furniture.
- Choking: a child chokes on an object such as a
piece of food or small toy.
- Confinement: a child is trapped in an airtight
place such as an unused refrigerator or toy chest.
- Strangulation: a rope, cords, hands or other
objects strangle a child.
The majority of these suffocations happen to infants while they are in
unsafe sleeping environments. These infants suffocate when another
person lays over them or when they smother in bedding or furniture.
This is the fourth leading type of accidental death for all children,
following motor vehicle crashes, fires and drowning. Infants who
suffocate often have no clinical findings at autopsy. It is only
through a comprehensive scene investigation that unintentional
suffocation can be distinguished from SIDS or intentional suffocations
(homicides). Yet, even with complete investigations, a large number of
suffocation deaths are still reported as manner undetermined, further
highlighting the difficulty investigators have in determining how the
Overlay deaths are most often caused when an infant sleeps with adults
or older siblings (bed-sharing). Bedding deaths occur when infants
sleep with too much bedding or when they sleep in beds other than
cribs. They suffocate because the bedding is usually too bulky or soft
for infants. Hazardous sleeping surfaces include waterbeds, couches,
large pillows, or soft or heavy comforters.
Researchers from the CPSC and the National Institute of Child Health
and Human Development are now reporting that infants sleeping in adult
beds are 20 times more likely to suffocate than infants who sleep alone
in cribs. Some proponents of bed- sharing argue that it promotes
breastfeeding. However, researchers have shown that many of the
benefits received from bed-sharing can be derived from the practice of
having the infant sleep on a separate, firm surface, but in the same
room with the mother. The majority of infants suffocate when another
person lays over them or when they smother in bedding or furniture. For
choking and strangulation deaths, toddlers and preschoolers are at
highest risk. Because they are active, they be-come entangled in cords
and gain access to small objects. Food and uninflated balloons remain
the number one and two choking hazards, again usually for toddlers.
Product safety improvements including rigorous scrutiny and recalls by
the CPSC on toys with choking hazards, removal of draws rings from
children’s clothing and safety cord hangers for window blinds have
reduced the number of these types of suffocations in recent years.
- Infants sharing sleep surfaces with other
- Unsafe infant bedding: may include couches,
waterbeds, poor-fitting crib mattresses, infant beds filled with
clutter, heavy or numerous blankets and soft mattresses.
- Easy access by infants and toddlers to small
objects, balloons and toys with small parts.
- Easy access by infants and toddlers to cords
- Toy chests without safety latches and heavy
furniture not secured to floors or walls.
- Place where child was sleeping or playing.
- Position of child when found.
- Type of bedding, blankets and other objects
- Faulty design of cribs, beds or other
- Number of and ages of persons sleeping with
- Obesity, fatigue, or drug or alcohol use by
persons supervising or sleeping with child.
- Quality of supervision at time of death.
- Child’s ability to gain access to objects
causing choking or confinement.
- If hanging, child’s developmental age
consistent with activity causing strangulation.
- Family’s ability to provide safe sleep or
play environment for child.
- Prior child deaths or repeated reports of
apnea episodes by caregiver.
for Case Review
- Autopsy reports
- Scene investigation reports and photos
- Interviews with family members
- Day Care Licensing investigative reports, if
occurred in day care setting
- EMS run reports
- Emergency Department reports
- Prior CPS history on child, caregivers and
person supervising child at time of death
- Child’s health history
- Criminal background checks on person
supervising child at time of death
- Reports of home visits from public health or
- Any information on prior deaths of children
- Any information on prior reports that child
had difficulty breathing
- Downloaded information from apnea monitors